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Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?

Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?

1

Get theFacts

2

CompareOptions

3

YourFeelings

4

YourDecision

5

QuizYourself

6

Your Summary

Get the facts

Your options

Have surgery on your fallopian tubes.

Have in vitro
fertilization.

Key points to remember

Fallopian tube surgery can reverse
infertility if a tubal problem is the cause. If you
get pregnant after tubal surgery, you shouldn't need more fertility
treatment.

In vitro fertilization (IVF) doesn't reverse
infertility. You need to have IVF each time you try to get pregnant.

You may be able to get pregnant sooner after IVF than after
surgery.

You'll need surgery if the tubal problem causes a buildup of
fluid called a
hydrosalpinx. Fluid that drains from a hydrosalpinx
into the uterus greatly reduces your chances of getting pregnant, with or
without IVF.

It's hard to know if treatment for a tubal problem
will work. Your chances of getting pregnant and having a healthy pregnancy
depend on how bad the tubal problem is, your age, and whether you or your
partner has any other fertility problems.

If you are age 35 or older, your doctor may recommend that you
skip the surgery and have IVF. After age 35, the chances of IVF working drop a
lot as each year passes. You may not want to spend time having surgery and then
waiting to see if you get pregnant.

Remove the diseased part
of the tube. This may be done to treat a
hydrosalpinx, which is a fluid-blocked fallopian tube
that may drain into the uterus. A doctor also may remove fluid, create a
drainage hole in the tube, or block the tube's opening to the uterus.

The success of fallopian tube surgery depends in part on the location and extent of the blockage. It may also depend on whether you have other fertility problems or pelvic conditions. Talk to your doctor about his or her success rates with any procedure you are considering.

Fallopian tube surgery may or may not lead to a healthy pregnancy. About
7 to 9 out of 100 women who get pregnant after fallopian tube surgery have an
ectopic (tubal) pregnancy, which can be dangerous.
This means that 91 to 93 out of 100 women who have the surgery don't have an
ectopic pregnancy. These pregnancies usually happen because of tubal damage the
women already had before surgery, rather than because of the surgery itself.footnote 1

For women age 35 or older, perhaps the greatest risk
is the time it takes to recover from surgery and then try to get pregnant. If
you want to try only tubal surgery, the sooner you begin, the better. If you
are thinking about having IVF with your own eggs, you may want to start IVF as
soon as possible, rather than having surgery.

During
in vitro fertilization (IVF), a woman's eggs are mixed with a man's sperm
in a lab. The resulting embryo or embryos are then transferred into the uterus.
Your doctor can use your eggs and sperm for IVF, or you can try donor eggs or
sperm if needed.

Most women begin the IVF process by having daily
hormone shots to grow multiple eggs. This is called
superovulation. The eggs are then collected, either
through a needle guided by
ultrasound or
laparoscope. The best-quality eggs are fertilized with
sperm, and the best
embryos are implanted in the uterus. Then you have a
series of hormone shots to support the first days of pregnancy.

Some women choose to use their own eggs naturally and not use
superovulation.

In vitro fertilization (IVF) was first used for women with no
fallopian tubes. Now this procedure is also used to
treat couples whose infertility is caused by:

Blocked or diseased fallopian tubes.

Severe
endometriosis.

A
tubal ligation, or surgery that wasn't able to reverse
tubal ligation.

Low sperm counts.

Unexplained
infertility that has gone on for a long time.

The success of IVF depends on many different things, including age, the cause of infertility, whether the woman has given birth before, and whether the woman's own eggs or donor eggs are used. Talk to your doctor about what to expect based on these and other factors.

In vitro fertilization (IVF) is emotionally and physically demanding. You need to have several
procedures to produce and collect eggs and then to implant embryos. IVF
increases the risks of:

Multiple pregnancy. About 31 out of 100
births in the United States that result from methods like IVF produce two or
more children.footnote 2 Multiple pregnancies are
high-risk for both the mother and the
fetuses.

You have a problem that causes fluid to build up in your
fallopian tubes.

A problem with your fallopian tubes is your only
fertility problem.

You are
age 34 or younger and are willing to take the time to have surgery, recover, and
then see if you can get pregnant.

Your doctor might recommend IVF
if:

You have severe tubal damage or
disease.

You are
35 or older. You may want to try to get pregnant as soon as you can, rather
than wait to recover from surgery and see if you get pregnant. The chances that
IVF with your own eggs will work drop a lot the older you get.

You want to get pregnant fairly soon, whatever your age. You
may be able to get pregnant sooner after IVF than after surgery.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have tubal surgery
Have tubal surgery

You stay in the hospital for
2 or 3 days, depending on the
surgery.

It takes from a few days to up to 6 weeks to recover, depending
on the surgery.

It
can help you get pregnant if a problem with your
fallopian tubes is your only fertility problem. Up to
60 out of 100 women who have a blockage close to the uterus are able to get
pregnant after the procedure.footnote 1 The chance of pregnancy
is lower if the blockage is near the end of the fallopian tube.

If the surgery works, you won't need to have more treatment each
time you want to get pregnant.

You may not get
pregnant after surgery. Your
chances of pregnancy after surgery depend on the type
of tubal damage you have.

You have a procedure to take the eggs out of your body and
another one to implant the fertilized eggs.

It
can help you get pregnant. Your chance of getting
pregnant depends in part on your age and whether you use your own eggs. Between
30 and 40 women out of 100 who use their own eggs and are younger than age 35
get pregnant with IVF.footnote 3 The odds of getting pregnant
with your own eggs are much less after age 35. But for women in their late 20s
through mid-40s who use donor eggs, the chances of getting pregnant are about
55 out of 100.footnote 3

You can avoid having surgery and then waiting to see if you get
pregnant.

You might be able to get pregnant sooner with IVF than
you can after surgery.

You may not get pregnant.
Your
chances of pregnancy with IVF depend on how good your
eggs are. (Donor eggs may improve your chances).

IVF can lead to
having twins or more. Pregnancy with more than one baby is
higher-risk.

IVF doesn't fix a fertility problem. So you need to do IVF
each time you try to get pregnant.

The average cost of one IVF
cycle is $10,000 to $15,000 in the United States. Health insurance often
doesn't cover IVF.

Personal stories about tubal infertility treatment

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

Since we
learned that I have blocked fallopian tubes, we've been going back and forth
about what to do. Time is ticking away, so we need to act soon. I've decided
that I'm willing to have surgery and keep trying to conceive for a year. My
hormone tests tell me that I'm still fertile, and who knows—maybe we could
actually have more than one child after fixing the problem. If not, we're
considering adopting.

Karen, age 36

I was
shocked to learn that my fallopian tubes were so badly damaged by the chlamydia
infection I had a few years ago. My doctor says that we can try surgery to
repair the tubes, but that my best bet is trying in vitro fertilization. We
can't possibly afford in vitro fertilization, and we're lucky that my provincial health plan
will cover the surgery, so I'm going to have the surgery and see if it helps.

Marianna, age
26

Now that we're ready to have a child, we're
really ready! We don't care what it takes. Our doctor tells us that in vitro
fertilization is really our only choice, considering my age. By the time I have
my tubes repaired and start trying to get pregnant, I'll be too old to have any
other options if that doesn't work. So, we're going to go for it and do the in
vitro fertilization. We figure we'll try it three times and hope one of them
takes.

Teri, age
39

I'm told that I have a small blockage in
one of my fallopian tubes that can be treated without surgery. The doc says she
can put a little plastic catheter in my fallopian tube to open up the blockage,
and I have a good chance of getting pregnant after that.

Anne, age 30

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons to have IVF

I want to have surgery and then wait and see if I can get pregnant.

I don't want to take the time to see if surgery will work.

More important

Equally important

More important

I don't want to go through a fertility treatment each time I want to get pregnant.

I want to get pregnant as soon as possible, even if I have to do IVF each time I want to get pregnant.

More important

Equally important

More important

I'm scared of having a bad problem from the hormones in IVF.

I'm not worried about side effects from taking hormones.

More important

Equally important

More important

I don't mind paying for the one-time cost of surgery.

I'm worried about the cost of IVF. I can't afford to have IVF each time I want to get pregnant.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Having IVF

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Which treatment can fix a problem with your fallopian tubes?

SurgeryYou're right. Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.

IVFSorry, that's not right. Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.

BothNo. Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.

I'm not sureIt may help to go back and read "Key points to remember." Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.

2.

Which treatment might your doctor recommend if you are 35 or older?

SurgeryNo, that's not right. If you are 35 or older, your doctor may recommend that you save time by going right to IVF.

IVFThat's right. If you are 35 or older, your doctor may recommend that you save time by going right to IVF.

I'm not sureIt may help to go back and read "Get the Facts." If you are 35 or older, your doctor may recommend that you save time by going right to IVF.

3.

Which treatment guarantees that you can get pregnant?

IVFSorry, that's not right. There's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on your age and other things for both tubal surgery and IVF.

Surgery to fix the fallopian tubesNo. Actually, there's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on your age and other things for both tubal surgery and IVF.

NeitherThat's right. There's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on your age and other things for both tubal surgery and IVF.

I'm not sureIt may help to go back and read "Key points to remember." There's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on age and other things.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery on your fallopian tubes.

Have in vitro
fertilization.

Key points to remember

Fallopian tube surgery can reverse
infertility if a tubal problem is the cause. If you
get pregnant after tubal surgery, you shouldn't need more fertility
treatment.

In vitro fertilization (IVF) doesn't reverse
infertility. You need to have IVF each time you try to get pregnant.

You may be able to get pregnant sooner after IVF than after
surgery.

You'll need surgery if the tubal problem causes a buildup of
fluid called a
hydrosalpinx. Fluid that drains from a hydrosalpinx
into the uterus greatly reduces your chances of getting pregnant, with or
without IVF.

It's hard to know if treatment for a tubal problem
will work. Your chances of getting pregnant and having a healthy pregnancy
depend on how bad the tubal problem is, your age, and whether you or your
partner has any other fertility problems.

If you are age 35 or older, your doctor may recommend that you
skip the surgery and have IVF. After age 35, the chances of IVF working drop a
lot as each year passes. You may not want to spend time having surgery and then
waiting to see if you get pregnant.

FAQs

What surgeries are done to fix fallopian tube problems?

There are
several types of surgery to fix blocked
fallopian tubes. The type of surgery you have will
depend on the type of blockage, where it is, and how bad it is. Surgery may be
done to:

Remove the blocked part of the tube, clear out scar tissue, or
put in a plastic tube to open the blocked area.

Remove the diseased part
of the tube. This may be done to treat a
hydrosalpinx, which is a fluid-blocked fallopian tube
that may drain into the uterus. A doctor also may remove fluid, create a
drainage hole in the tube, or block the tube's opening to the uterus.

The success of fallopian tube surgery depends in part on the location and extent of the blockage. It may also depend on whether you have other fertility problems or pelvic conditions. Talk to your doctor about his or her success rates with any procedure you are considering.

What are the risks of fallopian tube surgery?

Fallopian tube surgery may or may not lead to a healthy pregnancy. About
7 to 9 out of 100 women who get pregnant after fallopian tube surgery have an
ectopic (tubal) pregnancy, which can be dangerous.
This means that 91 to 93 out of 100 women who have the surgery don't have an
ectopic pregnancy. These pregnancies usually happen because of tubal damage the
women already had before surgery, rather than because of the surgery itself.1

For women age 35 or older, perhaps the greatest risk
is the time it takes to recover from surgery and then try to get pregnant. If
you want to try only tubal surgery, the sooner you begin, the better. If you
are thinking about having IVF with your own eggs, you may want to start IVF as
soon as possible, rather than having surgery.

What is IVF?

During
in vitro fertilization (IVF), a woman's eggs are mixed with a man's sperm
in a lab. The resulting embryo or embryos are then transferred into the uterus.
Your doctor can use your eggs and sperm for IVF, or you can try donor eggs or
sperm if needed.

Most women begin the IVF process by having daily
hormone shots to grow multiple eggs. This is called
superovulation. The eggs are then collected, either
through a needle guided by
ultrasound or
laparoscope. The best-quality eggs are fertilized with
sperm, and the best
embryos are implanted in the uterus. Then you have a
series of hormone shots to support the first days of pregnancy.

Some women choose to use their own eggs naturally and not use
superovulation.

What can IVF treat?

In vitro fertilization (IVF) was first used for women with no
fallopian tubes. Now this procedure is also used to
treat couples whose infertility is caused by:

Blocked or diseased fallopian tubes.

Severe
endometriosis.

A
tubal ligation, or surgery that wasn't able to reverse
tubal ligation.

Low sperm counts.

Unexplained
infertility that has gone on for a long time.

The success of IVF depends on many different things, including age, the cause of infertility, whether the woman has given birth before, and whether the woman's own eggs or donor eggs are used. Talk to your doctor about what to expect based on these and other factors.

What are the risks of IVF?

In vitro fertilization (IVF) is emotionally and physically demanding. You need to have several
procedures to produce and collect eggs and then to implant embryos. IVF
increases the risks of:

Multiple pregnancy. About 31 out of 100
births in the United States that result from methods like IVF produce two or
more children.2 Multiple pregnancies are
high-risk for both the mother and the
fetuses.

Severe
ovarian hyperstimulation syndrome, which can be
deadly. This happens in up to 2 out of 100 IVF cycles.1 Your doctor can reduce this risk by closely checking your
ovaries and hormone levels.

If you choose IVF, talk to your doctor about how to
reduce your risk of multiple pregnancy.

Why might your doctor recommend surgery or IVF?

Your doctor might recommend surgery on your fallopian tubes if:

You have a problem that causes fluid to build up in your
fallopian tubes.

A problem with your fallopian tubes is your only
fertility problem.

You are
age 34 or younger and are willing to take the time to have surgery, recover, and
then see if you can get pregnant.

Your doctor might recommend IVF
if:

You have severe tubal damage or
disease.

You are
35 or older. You may want to try to get pregnant as soon as you can, rather
than wait to recover from surgery and see if you get pregnant. The chances that
IVF with your own eggs will work drop a lot the older you get.

You want to get pregnant fairly soon, whatever your age. You
may be able to get pregnant sooner after IVF than after surgery.

2. Compare your options

Have tubal surgery

Have IVF

What is usually involved?

You stay in the hospital for
2 or 3 days, depending on the
surgery.

It takes from a few days to up to 6 weeks to recover, depending
on the surgery.

You have a series of hormone shots to
make multiple eggs.

You have a procedure to take the eggs out of your body and
another one to implant the fertilized eggs.

What are the benefits?

It
can help you get pregnant if a problem with your
fallopian tubes is your only fertility problem. Up to
60 out of 100 women who have a blockage close to the uterus are able to get
pregnant after the procedure.1 The chance of pregnancy
is lower if the blockage is near the end of the fallopian tube.

If the surgery works, you won't need to have more treatment each
time you want to get pregnant.

It
can help you get pregnant. Your chance of getting
pregnant depends in part on your age and whether you use your own eggs. Between
30 and 40 women out of 100 who use their own eggs and are younger than age 35
get pregnant with IVF.3 The odds of getting pregnant
with your own eggs are much less after age 35. But for women in their late 20s
through mid-40s who use donor eggs, the chances of getting pregnant are about
55 out of 100.3

You can avoid having surgery and then waiting to see if you get
pregnant.

You might be able to get pregnant sooner with IVF than
you can after surgery.

What are the risks and side effects?

You may not get
pregnant after surgery. Your
chances of pregnancy after surgery depend on the type
of tubal damage you have.

There is a chance of having an
ectopic (tubal) pregnancy after surgery. About 7 to 9
out of 100 women who get pregnant after the surgery have an ectopic
pregnancy.1

IVF doesn't fix a fertility problem. So you need to do IVF
each time you try to get pregnant.

The average cost of one IVF
cycle is $10,000 to $15,000 in the United States. Health insurance often
doesn't cover IVF.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about tubal infertility treatment

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Since we learned that I have blocked fallopian tubes, we've been going back and forth about what to do. Time is ticking away, so we need to act soon. I've decided that I'm willing to have surgery and keep trying to conceive for a year. My hormone tests tell me that I'm still fertile, and who knows—maybe we could actually have more than one child after fixing the problem. If not, we're considering adopting."

— Karen, age 36

"I was shocked to learn that my fallopian tubes were so badly damaged by the chlamydia infection I had a few years ago. My doctor says that we can try surgery to repair the tubes, but that my best bet is trying in vitro fertilization. We can't possibly afford in vitro fertilization, and we're lucky that my provincial health plan will cover the surgery, so I'm going to have the surgery and see if it helps."

— Marianna, age
26

"Now that we're ready to have a child, we're really ready! We don't care what it takes. Our doctor tells us that in vitro fertilization is really our only choice, considering my age. By the time I have my tubes repaired and start trying to get pregnant, I'll be too old to have any other options if that doesn't work. So, we're going to go for it and do the in vitro fertilization. We figure we'll try it three times and hope one of them takes."

— Teri, age
39

"I'm told that I have a small blockage in one of my fallopian tubes that can be treated without surgery. The doc says she can put a little plastic catheter in my fallopian tube to open up the blockage, and I have a good chance of getting pregnant after that."

— Anne, age 30

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons to have IVF

I want to have surgery and then wait and see if I can get pregnant.

I don't want to take the time to see if surgery will work.

More important

Equally important

More important

I don't want to go through a fertility treatment each time I want to get pregnant.

I want to get pregnant as soon as possible, even if I have to do IVF each time I want to get pregnant.

More important

Equally important

More important

I'm scared of having a bad problem from the hormones in IVF.

I'm not worried about side effects from taking hormones.

More important

Equally important

More important

I don't mind paying for the one-time cost of surgery.

I'm worried about the cost of IVF. I can't afford to have IVF each time I want to get pregnant.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Having IVF

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Which treatment can fix a problem with your fallopian tubes?

Surgery

IVF

Both

I'm not sure

You're right. Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.

2.
Which treatment might your doctor recommend if you are 35 or older?

Surgery

IVF

I'm not sure

That's right. If you are 35 or older, your doctor may recommend that you save time by going right to IVF.

3.
Which treatment guarantees that you can get pregnant?

IVF

Surgery to fix the fallopian tubes

Neither

I'm not sure

That's right. There's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on your age and other things for both tubal surgery and IVF.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

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